Healthcare Provider Details

I. General information

NPI: 1396407581
Provider Name (Legal Business Name): AMANDA BRINKMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA NIX

II. Dates (important events)

Enumeration Date: 10/06/2021
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5415 THOMPSON MILL RD
HOSCHTON GA
30548-4132
US

IV. Provider business mailing address

6397 LEE HWY
CHATTANOOGA TN
37421-2564
US

V. Phone/Fax

Practice location:
  • Phone: 770-965-3508
  • Fax:
Mailing address:
  • Phone: 219-877-4470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberOT008221
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT008221
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: